Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Scandalous and Dangerous Doctors

A very difficult problem: there is a doctor who diagnoses and treats a questionable post-injury condition. The doctor uses _new_ tests, implements _new_ and often radical procedures (some of which are invasive) and prescribes truly incredible levels of medications.

Thankfully, this kind of provider is actually rare, but when they do arise they tend to assume responsibility for those cases which others wish to avoid and/or feel cannot be directly helped.

So when someone comes into an area and offers to treat the untreatable, other providers are usually relieved to no longer have the responsibility for the patients and willingly step aside.

There are those patients who fit the diagnosis, and there are soon patients who become included in a far reaching (if not farfetched) definition of the diagnosis. Thus, the _disorder_ may occur in 1 of every 1,000 injuries but soon you will note that it is increasingly and more broadly defined and now 5-10 of every 100 now receive the diagnosis.

The patient becomes a victim of this process since patients are most often passive and accept what they are told, especially if told they have severe problems which no one wishes to address, which will only get worse, and only this provider has the skill to treat.

The provider then creates his/her own patient base which becomes very large and very vocal. Those with administrative capacity and responsibility, respond with _well at least he/she is willing to try to help these people._

What you are saying is that you are aware that overtime the patients are not helped, but increasingly harmed. They become dependent upon their ever increasing number of medications, spend the entirety of their days tracking medication, and now need care for adverse effects arising from treatment. They go from being capable of modified duty to obtunded in wheel chair and bed.

Their family and friends do not know how to assist and participate in the patient_s now entrenched perception of invalidism. Family may fatigue with the process, leaving the patient even more vulnerable to, and dependent upon, “care.”

This happened a decade ago with _chronic fatigue syndrome_ which was broadly applied to large numbers of patients.

So we can now expect that such diagnoses and self-appointed experts will arise and fill the void left by others who treat the patients conservatively.

Eventually, what is occurring_the over-diagnosis, over-treatment and iatrogenic disabling of the patient becomes well known, and the offenders see less and less cases as new and more appropriate differential diagnosis and effective care arises.

The most immediately available alternative is to find an examiner who can accurately diagnose the patient and explain to him/her the cause of the symptoms and the safest and most effective means of dealing with them. In smaller communities, this solution becomes more difficult.